Houston Metro Urology

Tuesday, February 23, 2016

Discussions in FPMRS (Female Pelvic Medicine and Reconstructive Surgery): Fixing vaginal prolapse and restoring pelvic function with Dr. Ricardo Gonzalez

Pelvic Organ Prolapse (POP) Surgery  affects as many as 200,000 known patients a year in the United States. However, it is estimated that over 70% of women with (POP) symptoms do not seek help from a FPMRS specialist (Female Pelvic Medicine and Reconstructive Surgery Physician). If you are feeling any of the following you could be a (POP) candidate and may need to consult your FPMRS physician.

  •       Vaginal pressure or bulge

  • ·         Pulling or soreness in your pelvic area, often with low back pain

  • ·         Feeling of fullness or heaviness

  • ·         Urinary or Fecal Incontinence

  • ·         Painful or uncomfortable sex 

There are multiple ways to approach a solution to your (POP). The deciding factors depend solely on you as a woman and what stage in life you are in. The less severe cases can be treated with a non- invasive approaches. 

Non-Surgical Options

The first line of defense is manual reduction (pushing in the bulge) with or without a device called a Pessary. This little wonder can be used for a number of gynecologic problems, but is most commonly used to control and manage pelvic defects such as rectocele and cystocele.  If you want to try a more “natural” and “fitness type” approach, performing an exercise called kegels for strengthening your pelvic floor as well as losing weight to alleviate the pressure in your pelvic area, can be beneficial as well. Pelvic Floor Muscle Therapy with a trained therapist can help make sure you are doing the exercises well.

But if these routes are not enough and your symptoms are too severe, maybe it’s time to think about surgery. There are several types of  surgeries that offer solutions for POP.

Surgical Options With and Without Mesh

There are multiple approaches to surgically correcting vaginal prolapse. These can be done through the abdomen (eg. robotic abdominal sacrocolpopexy) or the vagina (eg. sacrospinous ligament fixation or ureterosacral ligament fixation). These can be done with your own “native” tissue, biological grafts and tissue transfer, or it can be augmented with synthetic vaginal mesh.  The role of mesh is in these repairs is to “reinforce” the repair and attempt to make the repairs more durable with time. However, problems with synthetic vaginal mesh resulted in FDA warnings on pelvic floor mesh in 2008 and 2011; these warnings have frightened many patients away from surgery, but they have served to educate both patients and surgeons to consider the best option for each patient. Women with prolapse are now encouraged to see FPMRS specialists.

Dr. Ricardo R. Gonzalez has a particular interest in vaginal reconstructive surgery with native tissue and biological grafts, aiming to restore pelvic function without any visible incisions on the abdomen. In women who have not had a hysterectomy, there is often no need to remove the uterus, preserving vaginal length and sexual function in women who are sexually active. Most of the time, there is no need for synthetic mesh, as well. He has taught this operation nationally and abroad, and he has treated women from around the U.S. and internationally.

For women who are older and do not want to undergo a full reconstructive procedure, an obliterative surgery like colpocleisis may be right for them. This is primarily for older patients who are not sexually active;  after this simple procedure is completed, the woman is no longer able to have intercourse. The reason for this is that an obliterative procedure includes a colpoclesis, which closes off the vagina to provide support for the pelvic organs.

Talk to your FPMRS Specialist like Dr. Gonzalez to fine out what solution is best for you.

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